How do you deal with a rude/difficult patient?

[GillyRN]

I work in a surgical acute/oncology unit and I have been a nurse for 11 years. It's been a long time but recently I had a patient mock me while attempting to talk to them about their plan of care. This patient was very upset about being transferred to a stable unit in the middle of the night, to make room for telemetry on the other floor. The nurse came up to me and stated that her patient was really upset and he wanted to leave against medical advice. She was grabbing the forms already. This man was not ready for discharge at all. I didn't want him to leave because I was afraid that his health would worsen. I was genuinely concerned for his well being. I sat down in a chair at eye level and spoke to him. I started with, "Hi Mr BLANK my name is Gilly and I am the charge nurse. Can we talk for a minute?" He mocks my voice and says "You want to talk for a minute?" It was shocking. For a moment, I couldn't say anything because it was so awful. I said, "Yes, I do with you, if that's okay." Then he does it again except he repeats what I said in this awful tone. He begins to mock everyone in the room and then calling them "mfkers." The primary nurse comes in and gives him the AMA form and says, "Can you walk?" In my heart I'm like, "No! Don't go! Don't go!" Even though he mocked the crap out of me, I really don't want him to go - how strange is that?

Anyway, I froze. I felt like a terrible leader at that moment.

Have you ever had a patient make you feel that way? Make you question your own ability?

I let him get to me. I shouldn't have, but what would I have said?

If I can go back, I have a scenario in my mind. To set the limits and say, "Don't talk to me like that. I am trying to help you and all you are doing is verbally abusing me. Help me understand you. What is your problem and what can we do to make you feel comfortable?"

But, something tells me even that wouldn't help.

So, how have you handled difficult patients? Was there ever a time where you had to put your foot down if so, what did you say?

Thanks for your time.

[Nurse SMS, MSN, RN]

When a difficult patient wants to leave, I let them. There is only so much you can do and if they are determined not to hear you out, that's their right. This was a manipulative move by an individual who was trying to see if he could stay on a floor that likely gave him more attention than he would get on a med-surg floor. He was waiting for you to blink. You didn't. He left. The consequences are on him, not you.

I strongly advise you to grant yourself grace for being only human. If he was that sick, he will be back.

[JKL33]

This is going to be long and a bit detailed...hear me out if you can because I have done a lot of "personal research" on this topic and am now a self-certified expert. ??

3 hours ago, GillyRN said:

He mocks my voice and says "You want to talk for a minute?" It was shocking. For a moment, I couldn't say anything because it was so awful.

You must work toward not having that initial embarrassed internal reaction to begin with. You must do away with that first feeling of shock and insult. It's possible to learn to remove your own emotions from a situation in such a way that you don't feel whatever emotional dagger someone tried to deliver; it has no deleterious effect on you whatsoever and is simply viewed as "someone's mouth is moving."**

It starts with applying a couple of key concepts: Your reaction to adversity or difficulty is on you >> This holds true for the patient as well >> The (patient's) attack is not personal >>> It says nothing about you. Repeat: "This has nothing to do with me and says nothing about me or my character."

**Don't misunderstand, you are going to listen and observe very carefully to get to the bottom of the problem. You are mentally going to process the verbal and body language actions of the person. You need to do that so that you can respond correctly, help the person if possible, and come to some sort of solution/ending point. But the concept of "this is nothing more than someone's mouth moving" is for your emotional benefit, and what you are not going to do is process the words and actions through an emotional lens.

Get the emotion out, and bring in the self-control and reasonable response.

Successfully changing means that undue anxiety, fear, anxious behaviors, awkward/insulted-sounding responses, offended body language can all be eliminated.

When you remove those from the picture the patient instantly has less to fight against. Instantly! There just isn't any more positive reinforcement of their behavior.

On your end, you now have the mental and emotional space to: Speak clearly, calmly, at a normal and non-pressured rate, in a normal-to-lower tone. You can use some brief periods of silence because you aren't compelled to the reactionary and uncontrolled action of "defending" yourself. You can listen in a more focused way, you can take a second to think so that you don't promise what can't be promised or make compromises that aren't going to work.

Most of all: 1) you can focus on providing the patient with information that could help them make a better decision that is in their best interest, and 2) You are giving the patient space to maintain (or recover) their dignity, which makes it emotionally easier for them to make that better choice.

[JKL33]

Other elements (common to a lot of these scenarios) that warrant discussion:

3 hours ago, GillyRN said:

He begins to mock everyone in the room and then calling them "mfkers."

This situation should not be given an audience of those who are not there with the authority to provide solutions. Everyone out except for the authority person and a witness who can refrain from adding to the chaos.

One of the worst things is the cacophony of multiple random staff members who are each there getting shocked and offended and then trying to chastise the patient or make this stop in some other unproductive way. When this happens you have the patient becoming escalated, staff members saying things like, "you will not talk to us that way!!", making their own threatening retorts, or even commanding the patient to apologize. This is nothing but just pure fighting. It is not helpful. They need to leave.

*Even if the staff aren't doing any of these things (which isn't very likely) they are still providing an audience for the patient/behavior, and are also serving as a visual distraction from the patient's obligation to make a decision. He needs to stop this and stay, or he needs to go.*

[Snatchedwig, BSN, CNA, LPN, RN]

When I'm in those situations my demeanor changes from a loving professional to a resting B face. Maybe my face is off-putting but they usually know I ain't the one and they don't want none of this. From there I only interact when needed and get out ASAP. Don't internalize this.

[Nurse SMS, MSN, RN]

1 hour ago, JKL33 said:

Other elements (common to a lot of these scenarios) that warrant discussion:

This situation should not be given an audience of those who are not there with the authority to provide solutions. Everyone out except for the authority person and a witness who can refrain from adding to the chaos.

One of the worst things is the cacophony of multiple random staff members who are each there getting shocked and offended and then trying to chastise the patient or make this stop in some other unproductive way. When this happens you have the patient becoming escalated, staff members saying things like, "you will not talk to us that way!!", making their own threatening retorts, or even commanding the patient to apologize. This is nothing but just pure fighting. It is not helpful. They need to leave.

*Even if the staff aren't doing any of these things (which isn't very likely) they are still providing an audience for the patient/behavior, and are also serving as a visual distraction from the patient's obligation to make a decision. He needs to stop this and stay, or he needs to go.*

Exactly. My standard reply was that I would return shortly to see if the patient was ready to communicate productively and in the meantime I would be working on their AMA discharge.

[Crystal-Wings, LVN]

Ah, another entilted ****** (not you, the patient).